D.C. Week: VA Secretary Grilled Over Budget Request

Also, lawmakers and analysts discuss the high price of prescription drugs

WASHINGTON -- Veterans Affairs Secretary David Shulkin took some heat in the Senate for his department's 2018 budget proposal, while pricey prescription drugs were the topic at another Senate hearing. And the House is considering a bill likely to make physicians dance on their exam tables, if it passes.

VA Secretary Takes Heat For 2018 Budget

Senators and veterans castigated David Shulkin, MD, the new head of the Department of Veterans Affairs, for proposing to pull benefits from older, disabled veterans to expand care outside the VA in the department's latest budget proposal.

"I've been in public life long enough to know that if you want to know where things are headed you follow the money," said Sen. Jon Tester (D- Mont.), the top Democrat on the Senate Committee on Veterans Affairs at a hearing Wednesday Wednesday.

That the FY 2018 budget for the Department of Veterans Affairs increases funding for VA hospitals by 1.2% while increasing funding for the Veterans Choice Program by 33% is "disturbing," he said.

The Choice program was intended to provide additional care for veterans, not replace VA facilities, Tester added.

Lawmakers, Analysts Mull High Prescription Drug Prices

The high price of prescription drugs was a hot topic in the nation's capital this week, and although everyone agreed there was no silver bullet to solve the problem, outcomes-based payment was mentioned as part of the solution.

Dan Mendelson, president of Avalere, a healthcare consulting firm here, testified before a Senate committee Tuesday. He said his company's survey this year of 45 health plans' interest in outcomes-based payment contracts for pharmaceuticals -- in which prices for a specific drug are based on how good it is at treating a particular condition -- "showed that 70% of health plans were very enthusiastic about initiating these contracts, and about 25% said they had implemented them and that they were very successful. These programs are in place today, and could really be facilitated by making small changes to enable [better contracts between health plans and pharmaceutical companies]."

Jennifer Bryant, a senior vice president at the Pharmaceutical Research and Manufacturers of America, said at an event at the Brookings Institution that one problem that needs to be addressed is the way patients have to pay for their drugs -- even the high-cost ones -- up front at the pharmacy. "They can't spread out their payment over time, so we have seen all the cost-sharing for the year being squeezed into January and February," said Bryant. "Having that happen year after year for patients who have chronic conditions is really not a workable system."

House Considers Bill to Reform Malpractice Laws

A House vote on a measure to reform medical liability laws has been delayed, although a vote is expected in the coming weeks.

H.R. 1215, the Protecting Access to Care Act, would cap non-economic damages in medical liability cases at $250,000 in states that have not set a limit. (In those that already have their own caps, theirs would prevail.) The act would also:

Set a statute of limitations for filing malpractice suits at 3 years after the date of the injury, or 1 year after the plaintiff discovers -- or should have discovered -- the injury.

Repeal the "collateral source" rule, which says that damages a plaintiff receives cannot be reduced due to payments they are receiving for their injury from someone other than the defendant (such as worker's compensation).

Ban "joint and several liability" in successful suits, which makes each individual defendant fully responsible for paying the entire damage award if others can't pay.

The House Judiciary Committee held no hearings on the bill and passed it out of the committee by a vote of 18-17. The bill was originally scheduled to for a full House vote this week, but that was canceled.

Next Week

On Tuesday, a Senate Appropriations subcommittee will hold a hearing on the FDA's fiscal year 2018 budget request.

Also on Tuesday, the FDA's Endocrinologic and Metabolic Drugs Advisory Committee will hold a hearing to discuss a supplemental new drug application for Victoza (liraglutide) injection for an added indication of reducing the risk of major adverse cardiovascular events in adults with type 2 diabetes and high cardiovascular risk.

On Thursday, a Senate Appropriations subcommittee will hold a hearing on the National Institute of Health's fiscal year 2018 budget request.

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